Scroll down to find helpful information about common health ailments that can be helped with massage therapy. Newsletter titles include:

The Shoulder Guide.

All about Arthritis.

Dealing with Discs.

Fibromyalgia.

Frozen Shoulder.

Heading off Headaches.

The 5 Minute Massage.

For a printable newsletter with illustrations, please contact me and I'll be happy to email you one you can print out: ericlmt@cox.net

Shoulder Guide

Your shoulders are incredibly flexible joints that allow your arms to move through a large range of motion. They are used in almost every activity and they take a lot of punishment on a daily basis. As a result, they are prone to a wide range of injuries. It’s important to take good care of your shoulders because even small problems can quickly become debilitating if not taken care of immediately.

The Anatomy Lesson

The shoulder is made up of three bones. The humerus is the big bone in your upper arm. The clavicle (collar bone) attaches to your rib cage at one end and helps keep your shoulder out to the side of your body. The scapula (shoulder blade) is the third bone. Part of the scapula, the acromion, juts out and forms a roof over the top of the joint. Another part of the scapula forms a socket into which the round head of the humerus fits.

The upper arm is held in its socket by loose ligaments and four small rotator cuff muscles that cover the joint like a sleeve. Other back, chest and upper arm muscles help support and move the shoulder.

There is also a fluid filled sac in the shoulder called a bursa. This bursa is like a cushion that helps prevent the tendons from rubbing against the bones.

Shoulder Problems

The shoulder is prone to a variety of problems that can give you pain and limit your range of motion. Many of these are simply caused by wear and tear. For example, a common injury is tendinitis of one of the rotator cuff muscles called the supraspinatus. Through poor posture or overuse, the tendon becomes inflamed and painful. When the bursa becomes inflamed you develop what is known as bursitis. This can be extremely painful.

Trigger points, small knots in the muscles, are very common around the shoulder and can refer pain and tenderness into the muscles or joints. The referred pain can mimic other shoulder problems like tendinitis and frozen shoulder.

Sprains and dislocations typically result from falls. It’s natural to reach your arm out to catch yourself when falling, but the impact can strain or tear the shoulder ligaments. If the impact is severe enough, the humerus may be knocked right out of the socket and the shoulder becomes dislocated.

With a severe trauma, the bones may actually fracture or break. The collarbone is most likely to break although the humerus can sometimes break as well. When this happens the arm needs to be immobilized. Fractures can take up to three months to heal.

Whenever you have a shoulder problem, you tend to limit your movement to minimize the pain. This can lead to frozen shoulder. Your shoulder becomes stiff and you quickly lose mobility. It can soon become extremely painful to lift your arm. If you develop a frozen shoulder, it will take a long time and lots of therapy to regain your normal movement. Sometimes the only option is surgery. The best medicine in this case is prevention. As soon as you develop any pain or discomfort in your shoulder, see your massage therapist immediately for assessment and treatment. Don’t risk getting this serious and debilitating shoulder condition.

Massage Therapy Can Help

Massage therapists can help when shoulder problems occur. More importantly, they can help prevent these kinds of problems from happening in the first place. Massage therapists will evaluate your shoulder through range of motion tests and other assessment procedures. They can then give you recommendations on the best course of treatment.

Their first priority is to make you feel more comfortable by getting rid of your pain. They can do this with specialized massage techniques. They may also use heat or hydrotherapy. To help the process along and to help prevent further problems your massage therapist can also give you exercises to help strengthen your shoulder and help maintain your mobility.

Many massage therapists are trained to treat trigger points. As mentioned previously, these knots mimic other common shoulder conditions and are often an overlooked source of pain. Your massage therapist will be able to tell you if trigger points may be playing a role in your shoulder problem.

Consult your massage therapist or doctor if you injure or develop pain in your shoulder, even if it seems minor

Do any maintenance exercises prescribed by your massage therapist

If you’ve injured your shoulder, your massage therapist will likely prescribe some exercises to help you regain the strength, flexibility and range of motion in your shoulder. Below are two typical exercises given to people with shoulder injuries.

All about Arthritis

You will develop arthritis at some point in your lifetime. It can be very mild, causing a little stiffness as you age, or it can be extremely painful and debilitating. Fortunately, there are things you can do to prevent and manage this condition.

Arthritis is not actually a disease. Arthritis is a term used to describe joint inflammation (“arthro” = joint; “itis” = inflammation). When inflammation is present, the joint is usually painful. However, not all joint pain is arthritis. Problems like trigger points, sprains, or tendinitis can cause pain, but the joint itself remains healthy.

To help you understand arthritis, it’s useful to know a little bit about joints. Joints are like hinges between bones. The surfaces where the bones connect are covered with cartilage; you would recognize this as gristle on a chicken leg. Cartilage is a smooth material that acts as a shock absorber and allows the bones to glide smoothly over one another. Ligaments (fibrous structures that attach one bone to another bone) surround the joint to form a sleeve that encapsulates the joint. Inside that sleeve is a slippery fluid called synovial fluid. This fluid lubricates the cartilage much like oil lubricates the parts of an engine.

There are virtually dozens of problems or pathologies that are considered arthritis. Two of the most common are osteoarthritis and rheumatoid arthritis.

Osteoarthritis

Doctors will often refer to this type of arthritis as degenerative joint disease, or if it affects the back, degenerative disc disease. It sounds scary, but it’s the most common and least serious type of arthritis. Osteoarthritis is simply wear and tear of the cartilage on the ends of the bones. One research study found that 37% of all adults have osteoarthritis in their hands or feet. Everyone over sixty-five years of age has it to some degree. However, because the cartilage is not sensitive to pain, you most often do not know you have it.

Stiffness is a key feature of osteoarthritis. Typically, your joints feel stiff in the morning and will loosen up after you move around for awhile. Sometimes the joints will make crackling or crunching sounds with movement. In the early stages, you will only feel pain after excessive activity. The pain is usually an aching sensation within the joint. You will seldom see swelling because inflammation in the joint tends to be minimal.

Rheumatoid arthritis

Rheumatoid arthritis is not nearly as common as osteoarthritis. It occurs in only about 1% of adults.

This type of arthritis is called systemic arthritis because it can affect many of your body systems. For example, it can affect your heart, lungs, nerves and skin. Whereas osteoarthritis usually develops as you get older, rheumatoid arthritis can occur at any age.

Usually the symptoms appear over a period of weeks or months and are accompanied by fatigue, fever, and diffuse pain. Subsequently, specific joints become inflamed and are painful, tender, swollen and red. Many joints become involved and both sides of your body are affected equally. There are periods when it goes into remission. It’s progressive however and overtime the involved joints often become somewhat deformed.

Other arthritic conditions

Most other types of arthritis are relatively rare. These include lupus, ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome, and many others. These are all systemic conditions. What differentiates each of these is the specific joints that become affected, the problems that occur in other body systems, and the severity of the symptoms.

Help is available

Treatment of rheumatoid arthritis and other types of systemic arthritis most often involves the use of medications in conjunction with massage, joint mobilization and exercise. By following this type of regimen, a person can usually minimize their pain and discomfort significantly.

You will eventually develop osteoarthritis at some point. If it starts to give you problems, it can usually be managed very will without medication. It is vitally important, however, that you take proactive measures to prevent wear and tear on your joints. You must manage your tension and maintain good posture to prevent excessive or uneven pressure on your joints. You can do this by practicing relaxation exercises, stretching and by having regular massage. If you want to learn how to improve your posture ask your massage therapist to do a postural assessment and to suggest some simple exercises to help correct imbalances. Many therapist are also trained in fascial or deep tissue techniques that will allow them to manually stretch out shortened muscles that are pulling your body out of alignment.

Do you have to stop exercising because your cartilage is wearing thin? Far from it. You need to move your joints to get nutrients to your cartilage so it can heal. Inactivity can actually cause your cartilage to deteriorate faster. If you have a sedentary job, make sure that you take frequent breaks. As well, engage in some low impact activities like walking, swimming, biking or any activity that you enjoy doing on a regular basis. If you need help starting a program ask your therapist for assistance.

In the case of osteoarthritis, you should consider surgery only after conservative treatment has failed and pain and limitation in movement interferes with your day-to-day activities in a significant way.

With arthritic conditions, some joints will lose their mobility, while other joints will tend to become hypermobile. Your muscles have to work harder to both compensate for lost movement and to stabilize loose joints. Remember that cartilage doesn’t feel pain. The pain associated with arthritis usually comes from overworked muscles or sometimes from the capsule that surrounds the joint. For this reason, massage therapy can be invaluable in managing your symptoms: general massage to reduce muscle spasm, trigger point therapy to reduce referred pain, and when necessary, joint mobilization to stretch tightened joints and restore your mobility.

CLIENT PROFILE

Bob Devlin is a client who knows that massage can do more than just help you relax. His experience illustrates just how effective massage therapy can be in treating osteoarthritis, even when the symptoms are quite severe.

“I first saw a massage therapist seven years ago. I had wanted to try massage for relaxation, but it was shoulder pain that forced me to go. That problem went away with massage. About that same time, I started to experience some discomfort in my left hip, although it wasn’t pronounced.”

Bob stopped seeing his therapist for about six months. When he returned, the hip pain had worsened considerably. As well, movement of his hip had become very restricted. He saw his doctor and had x-rays taken. The doctor suggested a pain medication, which Bob didn’t feel was effective. At one point Bob went to an orthopedic surgeon who talked about surgery on his hip. “I wasn’t at all wanting to do that, so I declined the offer.”

His therapist massaged his hip and leg, focusing on trigger points that were referring severe pain down the outside of his leg. Then the therapist began joint mobilization techniques. “After we began the mobilization, the hip became much better. Walking which was so painful in the past has become much easier. I don’t have the problems I had. There is definitely something that can be done using massage therapy. It worked!”

Dealing with Discs

Your back consists of stacked bones called vertebrae. There are discs between the vertebrae that act as shock absorbers and that allow the spine to bend. Each disc consists of a soft semi-fluid center (the nucleus) that is surrounded and held together by strong ligaments.

The discs in your spine can be the source of a great deal of back pain. This pain can range from a nagging ache and sciatic discomfort to excruciating pain that incapacitates you. There are simple measures you can take to reduce the risk of disc problems occurring and to reduce your pain once problems do occur.

To understand how disc pain happens, it is important to understand normal posture. When standing upright there is a natural inward curve in the lower back called a lumbarlordosis. With this natural lordosis, your body weight is distributed evenly over the discs.

The lordosis is lost whenever you slouch or bend forward. Back problems develop if you find yourself in these positions for long periods of time. This occurs because the vertebrae are placed in a position that pushes the nucleus backwards and stresses the ligaments at the back of the disc.

If the pressure on the ligaments is severe enough they may become weak and allow the soft inside part of the disc to bulge outward (prolapse) and press on the spinal nerves. This can cause sciatic pain in the buttock or down the leg.

Prevention is best

Ideally, you want to stop back pain from developing by taking some simple steps to reduce strain to your back.

Many chairs don’t offer sufficient support for your lower back. Even well designed chairs can be used improperly. For example, most people sit in the middle of the seat and then slouch backward against the back support.

It is important to maintain the natural lordosis in your lower back while sitting. You can use a specially designed lumbar support that can be attached to your chair or simply roll up a medium sized towel and place it between your lower back and the backrest of your seat.

As well, stand up regularly, put your hands on the back of your hips and bend backwards five or six times.

Many activities around the home like gardening, making the bed and vacuuming cause you to stoop forward. Make sure that you stand upright occasionally and bend backwards to relieve the strain on the back ligaments. If you are doing any lifting, make sure to keep your back straight and bend from your hips and knees.

In the event that your back starts hurting be sure to see your massage therapist right away. They’ll be able to help you out or refer you to a qualified medical professional.

Here are several extension exercises you can do to recover from low back pain, specifically acute episodes ofback pain ‑ when your back “goes out.” They put the vertebrae in a position that pushes the soft centre of the disc forward so it stops pushing on the ligaments or nerves in the low back.

Before beginning, consult with your massage therapist to be sure that they are appropriate for you. Do them in the order outlined. When doing these exercises you should move until you just start to feel discomfort and then return to the starting position If you do these exercises every two hours, about six to eight times per day, you should notice a significant change in pain within one to two days.

Closely observe the location and intensity of your pain. If your pain becomes less diffuse and localizes to your back or if the pain becomes less intense, you’ll know these exercises are working. If the pain intensifies or starts to spread further from your spine, especially below the knee, stop exercising and get advice from your massage therapist.

Lie face down with your head turned to the side. If your neck is uncomfortable in this position, roll up a towel and place it under your shoulders. Take deep breaths and consciously try to relax the muscles in your lower back. Stay in this position for about five minutes.

Remain face down. Place your elbows directly under your shoulders so that you are leaning on your forearms. Take deep breaths and allow your back to relax completely. Hold this position for about five minutes. This exercise should be done only once per session after Exercise 1.

Place your hands under your shoulders. Straighten your arms and push your body upwards. Let your pelvis sag and rest on the floor. Relax the muscles around your low back and hips completely. It is important that you hold this extended position for one to two seconds before you lower yourself to the starting position. If you feel that the pain is decreasing or localizing, you may hold the position for a little longer.­Repeat this exercise ten times after having completed Exercise 1 and 2.

Q&A

What is sciatica?

The sciatic nerve is a large nerve that begins at the base of the spine and that passes through the buttocks and continues down the back of the thigh and into the lower leg. This nerve can become compressed or inflamed. If this occurs, pain begins to travel down the back of your leg.

This pain is referred to as “sciatica”. Sciatica can be caused by a bulging disc, arthritis of the spine, a tight piriformis muscle in your buttocks and even trigger points in your muscles. Depending on the cause and the severity, you could also experience numbness, tingling or weakness in the leg. If you experience any of these symptoms, see your massage therapist as soon as possible for assessment.

Fibromyalgia

Do you seem to be tired all the time, even after you’ve had a full night’s sleep? Do you feel stiff every morning? Do you ache all over? Do you get frequent headaches?

These symptoms could be the result of stress. However, if you experience these feelings over a long period of time, it could indicate that you have a condition called fibromyalgia.

Because the symptoms are so common, many people go undiagnosed for years with this increasingly prevalent chronic pain disorder. Next to osteoarthritis, fibromyalgia is the most common rheumatic disease. It affects approximately 2% of the population and it is estimated that up to 20% of patients that see a rheumatologist (a doctor specializing in arthritis) are suffering from fibromyalgia.

This condition is sometimes referred to as fibrositis or fibromyositis. It usually affects women between the ages of 20 and 50. It’s a syndrome that causes chronic, sometimes debilitating muscle pain. The pain usually occurs where muscles attach to bone and is similar to the pain of arthritis. The good news is that the joints themselves are not affected. The joints do not deteriorate or become deformed as they do in some types of arthritis.

Pain is the most prominent symptom. It usually occurs in the neck, shoulders and back. People with fibromyalgia describe the pain in many ways. Some people report a stiff, aching feeling. Others describe a burning, stabbing, gnawing or radiating pain.

Pain isn’t the only symptom. (See the symptom chart on the next page.) Many people also experience generalized stiffness. Remaining in one position for extended periods of time, for example sitting for a long car ride, can increase the stiffness. For this reason, it seems to be worse first thing in the morning.

Fatigue is another almost universal symptom. About 90% of sufferers report moderate to severe fatigue. They feel a lack of energy, less endurance with exercise, or the kind of exhaustion associated with the flu or lack of sleep. This can interfere with concentration. Even simple mental tasks can seem extremely difficult.

Other common symptoms include swelling, tender points, headaches, insomnia, depression and neurological problems like numbness and tingling in the limbs.

Fibromyalgia is very difficult to diagnose because the symptoms mimic those of stress and other diseases. To add to the problem, there is no definitive laboratory test that can be done to confirm that you have the condition.

Because the diagnosis is made primarily on the basis of the reported symptoms, people with fibromyalgia are often led to believe that it’s all in their heads and that nothing is wrong.

It’s a mystery

Nobody seems to know what causes fibromyalgia. Originally it was thought to be some type of arthritis, but no signs of arthritis or inflammation have been found. A number of theories have been developed to explain these mysterious symptoms.

Some researchers hypothesize that muscles undergo microtrauma during everyday activities but are repaired during restorative sleep. People with fibromyalgia seem to have a particular sleep disturbance so that the restorative sleep stage does not occur properly. Others believe that the nervous system causes problems with normal circulation and as a result there is a deficiency of oxygen reaching the body tissues. This lack of oxygen, hypoxia as it is often called, has been linked to tenderness, fatigue and post-exercise soreness.

There is also some evidence that the symptoms may be the result of a deficiency of certain growth hormones or hormones produced by the adrenal glands. Other theories about the cause of fibromyalgia involve some unidentified virus and physical or emotional trauma, such as a car accident or physical or emotional abuse. The one thing that most experts do agree on is that it is not psychological. Fibromyalgia is a real disease with a definite, although undiscovered, physical cause.

Treatment

Treatment of fibromyalgia requires a comprehensive approach. Physicians typically prescribe low doses of antidepressant medications to improve sleep, elevate mood and relax muscles. For whatever reason, anti-inflammatory medications like aspirin, Advil, Voltaren, and Naprosyn don’t seem to work very well. About 75% of all fibromyalgia sufferers seek some form of alternative healthcare and massage is a popular choice.

Massage can be an extremely useful tool for helping you get relief from symptoms. One study conducted by the Touch Research Institute at the University of Miami found that 30-minute massages two times per week had a long-term effect on symptoms. In addition to being more relaxed, the subjects of the study had less pain and stiffness, reduced depression and fatigue and more comfortable sleep.

Because of the widespread tenderness, your massage therapist will likely need to adjust the pressure to make the massage comfortable. A typical one-hour session may sometimes seem too intense therefore the massage time may need to be shortened. Although the techniques used may vary, the massage treatment will largely focus on relaxation and stress reduction.

The relief provided by massage may last anywhere from a few hours to many weeks. You’ll need to determine with your therapist how frequently you’ll need to come in to maintain a significant level of relief. A once weekly treatment that is typically used for relaxation massage may be helpful. However, it may be more beneficial to have a massage several times a week, gradually reducing the number of sessions, making sure that you return before the effect of the last treatment has subsided.

You may also find some relief with the application of heat. Hot baths or showers, a hot water bottle or a heating pad may all be helpful in managing the symptoms. During a treatment, the therapist may put some type of heat pack on the areas that are most tender.

Research has also shown that moderate aerobic exercises like walking and swimming can help alleviate painful symptoms. Start off slowly. Monitor your response to exercise before increasing the duration and intensity. Ask your therapist for suggestions.

Frozen shoulder

As far as joints are concerned, the shoulder is truly remarkable. It moves in absolutely every direction. The only other joint that is even somewhat close in terms of the different types of movement is the hip. But even there, the mobility is much more limited.

You need a lot of movement in the shoulder to perform everyday activities. The ligaments that hold the upper arm bone, the humerus, in the socket are quite loose to allow for this wide range of motion. Because they are lax, they don’t do much to hold the shoulder together.

What really holds the shoulder together and stabilizes the joint are muscles that are referred to as the rotator cuff. There are four small muscles that run from the shoulder blade to the humerus. These muscles completely surround the humerus like a sleeve or cuff. They are very dynamic, contracting to stabilize the shoulder when needed or relaxing to allow you to move the arm freely. The movement of our shoulder is so free and easy that we often take it for granted.

How does a shoulder “freeze“?

Frozen shoulder, also called adhesive capsulitis, usually starts with a minor injury. For example, you may jar your shoulder by tripping and breaking your fall with an outstretched arm. It may also start after an inflammatory problem, like a little tendinitis or bursitis of the shoulder.

Because the shoulder is painful, you’ll often limit your movement or stop using your shoulder to avoid any discomfort. Although it’s important to rest your body if it’s injured, the rest period should be limited to just the first 24 to 48 hours following an injury. If you restrict your movement for any longer than that, adhesions, constricting bands of fibrous tissue, start to form within the shoulder joint.

You are always moving your shoulders, even if it’s brushing your hair or reaching behind you to close the car door. Because of this ongoing movement, adhesions don’t normally have an opportunity to develop. Limit your movement for several days, however, and this fibrous tissue starts to stick to the ligaments in your shoulder, especially in the lower part of the joint where the ligaments are most lax.

Once these adhesions begin to form, the shoulder starts to feel stiff and uncomfortable. You’ll limit your movement in response to the pain and the reduced movement causes more stiffness. Before you know it, you’re trapped in what seems to be a vicious cycle.

If you don’t take care of the problem immediately, it will progress from a little discomfort to severe pain that interferes with your daily activities and your sleep. It can become difficult or impossible to do simple things like brushing your hair, doing up your bra behind your back or even reaching your arm back to put it into the sleeve of your coat.

Over time, you will be unable to lift your arm. Your shoulder, in a sense, becomes frozen, hence the name. The pain in the shoulder can be intolerable and will likely spread into your neck and arm as your body tries to compensate for the lost movement.

If you catch the problem early, you can recover relatively quickly with some regular massage and some self-care exercises that you can do at home. Otherwise expect a lengthy and somewhat uncomfortable course of treatment to regain your normal pain-free movement.

The conventional treatment for a severe case is manipulation under anesthetic. A surgeon will put you under and while you are asleep will force your shoulder through a full range of motion to pull apart the adhesions. Sometimes surgery is used. In either case, don’t expect a quick fix. This kind of treatment is usually followed by several months of physical therapy or massage therapy.

For moderate cases, doctors may use oral anti-inflammatory drugs, or they may inject cortisone or anesthetic medications into your shoulder to reduce the pain and inflammation.

Your massage therapist will typically treat frozen shoulder through a combination of massage techniques, stretching and possibly joint mobilization procedures. This will be combined with exercises that you must do between treatments. Your therapist will suggest a treatment schedule that is best for you. You’ll likely need frequent short treatments that may last for many weeks.

An ounce of prevention …

Benjamin Franklin is noted for saying, “An ounce of prevention is worth a pound of cure.” This cliché couldn’t be any more true when it comes to frozen shoulder. To avoid the pain, disability and cost associated with treating frozen shoulder, be proactive.

If you injure your shoulder, see your massage therapist immediately. They can help you with the problem and give you exercises to prevent frozen shoulder from developing. It’s usually minor shoulder injuries that lead to frozen shoulder, so don’t think that because it’s a small injury that it will be fine if left alone.

If you have any shoulder pain, even minor pain that lasts for more than two days, pick up the phone and call your massage therapist. Unless you’ve seen someone with frozen shoulder, it’s hard to understand the pain and suffering you’ll save yourself.

The frozen shoulder mimic

Here’s something that most health professionals, including your doctor, don’t likely know: Trigger points in one of the rotator cuff muscles can mimic the exact same symptoms as frozen shoulder.

There’s a rotator cuff muscle underneath the shoulder blade (scapula) that is called subscapularis. It can develop knots or trigger points that cause symptoms that are almost exactly like symptoms of frozen shoulder. These knots refer pain into the shoulder in the same way and cause your movement to be limited in a similar pattern.

Unlike frozen shoulder, however, these trigger points can be deactivated, sometimes very quickly. Relief can be had after only a few sessions.

Most massage therapists are able to assess for these trigger points and help eliminate them from your muscles. So if you suspect that you are developing frozen shoulder, book an appointment with your massage therapist so they can check for this frozen shoulder copycat.

Your therapist may do hands on work to the muscle to get rid of the knot or they may use a gentle stretch technique where they will have you first contract and then relax the muscle as they pull it into a stretched position. There are a variety of approaches that can be taken and your massage therapist will choose the most appropriate techniques for your needs.

Heading off headaches

Except for head colds, headaches are the most common human ailment. In fact, headaches beat out backaches as the number-one cause of time lost from work. Approximately three out of every four people will have at least one headache within the year.

Some headaches, like migraines, are caused by a disturbance of brain chemicals called neurotransmitters. However, according to Dr Janet Travell and Dr David Simons, specialists in musculoskeletal pain, “It is now becoming clear that tension headache is usually due to trigger points.”

Trigger points are small knots that develop in muscles. These knots or mini-spasms make pain travel to different areas of the body, often nowhere near the knot itself. For example, trigger points at the top of your neck can send pain directly into your eye.

The name trigger point comes from the fact that these knots can sit in your muscles for ages without causing pain until something “triggers” them to become active. Common triggers include fatigue, stress, poor posture, repetitive movements at work and cold drafts.

Massage therapy is a proven way of treating trigger points for long-term headache relief. In one study, researchers found that chronic headache sufferers had dramatic relief after ten massages that focused on treatment of trigger points.

Although you may get some relief with general relaxation massage, long-term relief depends on correctly identifying and treating specific trigger points which are responsible for your pain. Single muscle trigger points can often be eliminated quickly and easily, sometimes within one or two treatments.

In more complicated cases however, it may take significant time and your active participation to get lasting results.

When should you see a doctor?

In a small number of cases, severe headaches may be a warning sign of a more serious disorder such as very high blood pressure, stroke, bleeding in the brain or even a tumour. The following signs should send you to a doctor immediately:

·you suddenly start having severe headaches, especially if they are your first ones and you are over 35 years of age

you have a severe headache during or immediately after physical exertion or straining

·a headache with fever and neck stiffness

·a headache accompanied by confusion or difficulty speaking—especially following a blow to

the head, even one that occurred several weeks earlier

·a headache accompanied by inflamed, clogged sinuses – it may be the result of infection and

build-up of pus in the sinus passages

any increase in the intensity or frequency of headaches

your headache treatment guide

Many people use painkillers to get rid of their headaches. Don’t take painkillers for extended periods without consulting with your doctor. Because some medications, even over the counter drugs, have unpleasant and sometimes dangerous side effects it’s always best to rely on non-drug treatments when possible. Here are a few suggestions:

Relaxation training. Relaxation has been shown to be extremely effective in the management of headaches. For example, one study published in the journal Headache in 1989 found that migraine sufferers who were taught relaxation exercises had 30% to 40% fewer attacks over the course of three years. The subjects were also better able to cope with the attacks when they occurred and required less medication.

Massage. This is one of our favorites simply because we know it works so well. Many people think that massage provides only short-term relief. However, research shows that not only is massage effective at eliminating headaches, but the relief can last for months. Part of the effectiveness lies in the elimination of trigger points. As well, regular massage can actually retrain your nervous system to decrease the tension in your muscles on a more permanent basis.

Cold. Reusable gel packs are an inexpensive and simple solution that can be used in place of or as an adjunct to medication. Keep the gel pack in the freezer. At the first signs of a headache put it in a tea towel and wrap it around your neck. About 70% of headache sufferers will experience some relief with the use of gel packs. If your headache gets worse after applying the pack, it is possible that the cold pack may be aggravating a trigger point.

Heat. Some people find that heat is better than cold at relieving headaches. Most gel packs can also be heated. They are generally safer and more effective than heating pads because they mold nicely to the shape of our neck and are less likely to cause burns. A hot bath or hot shower may even be better. Headaches caused by trigger points generally respond well to heat, whereas migraine headaches may be aggravated.

Exercise. Regular exercise helps relieve stress and tension and thus can be an excellent way to prevent headaches. Neck, back, and shoulder stretches also help relieve tension and are essential for trigger point headaches. Ask your massage therapist for stretches that are appropriate for you.

Improved posture. Sitting improperly, at a computer terminal for instance can create tension in the muscles and trigger a headache. Slouching is particularly problematic as it prevents you from breathing normally and shortens the muscles in the back of your neck.

Get to the cause. A headache may be your body’s way of telling you that there is some underlying stressful problem in your life: a troubled relationship, an unfulfilling job, or an upcoming exam. Your headaches may go away only after these stressful situations are resolved.

If you have specific health concerns consult your medical doctor. The information in this newsletter

is educational only and is not intended to replace the advice of your personal health care providers.

The five-minute massage

In this stressed-out world, nothing beats a neck and shoulder massage. A simple shoulder rub or back massage can be incredibly relaxing.

Giving an effective professional-level therapeutic massage is something that requires training and years of practice. You probably don’t want to go through that. However, here are some simple techniques that will aid you in providing someone with a short, safe and simple massage.

The massage techniques outlined here are of limited therapeutic value. You won’t be able to fix tendinitis or get rid of chronic headaches, but you certainly will be able to help your partner relax a little and release some tension.

Some simple rules

While most people love and welcome a quick shoulder rub, check with your partner to be sure that they want a massage before starting to knead those muscles.

If the person has any severe pain or has had any recent injuries to the neck or shoulder area, don’t do this massage. Instead, suggest they see a massage therapist. While the massage may feel good, it could aggravate their condition.

The massage should not be painful. It should feel good. Pain will make your partner tense up and defeats the purpose of the massage. So be sure to check in occasionally to find out if the pressure is comfortable.

If you feel something that feels hard like a bone, it probably is a bone. Don’t massage it. Bones don’t relax. Bones also tend to be very pain sensitive. So everything you massage should feel relatively soft.

Don’t wreck your body

If you’ve tried to give someone a massage in the past, you may have found that by the time they felt relaxed your hands and arms ached. Follow these simple principles and you’ll be able to give a relaxing massage without feeling like you’ve wrecked your body:

Keep your shoulders relaxed

Keep your back straight and avoid bending excessively

Relax your hands between each movement

Use a slow, even pace

Use your thumbs as little as possible

And now, the techniques

We’ll illustrate some techniques to the shoulders and the neck. You’ll do these techniques while your partner sits upright in a regular chair. They can be done anywhere – in the office or at the kitchen table. You can repeat any of these techniques several times before going onto the next one.

The shoulder muscle is called the trapezius muscle. Massage therapists usually just call it the “traps.” This is easy to remember because this is where most of us trap our tension. The first technique is a simple compression movement that uses the forearms.

Stand behind your partner and rest your forearms on the top of their shoulders as close to the neck as possible (Figure 1). Keep your palms down so the fleshy part of your forearm, not the bony part, lies on the muscle. Let your weight fall straight down onto their shoulders toward their seat. Avoid pushing them forward and be careful that you don’t lean on their head. Hold this for several seconds. Slowly lift the arms and move them down the shoulder one inch. Let your weight fall through your arms again. Repeat this process several times. As soon as you start to feel the bony part of their shoulder under your forearm, stop, bring your forearms to the starting position and repeat the technique again. This forearm compression technique is simple to do, but feels fabulous.

Now, move to the side of your partner. Feel the tip of the shoulder with your fingers. It will feel hard and bony. Move your fingers toward the neck until you feel some soft muscle under your fingers. Place your thumbs on that spot (Figure 2). Put one thumb on top of the other for reinforcement – each thumb will be doing just half the work.

Press straight down with the thumbs. You’ll be pressing on the trapezius muscle again. Press down slowly, then hold the thumbs in the muscle for a couple of seconds and then slowly ease off the pressure. Move one thumb width towards the neck and repeat the compression. You should be able to do four to six compressions before you reach the neck. Once you reach the neck, move your thumbs back to the starting position and do a second set of compressions to those same points. Move to the other side of your partner and repeat these compressions to the other shoulder.

For this third technique, you’ll have to stand behind your partner. Drape one hand over each shoulder (Figure 3) as close to the neck as possible. Squeeze the trapezius between the fingertips and the heel of the hand. Keep your thumb beside your index finger so that it stays out of the way. Hold the squeeze for a couple of seconds and then slowly release your grip. Move out one inch toward the shoulders and repeat. You should be able to get three or four squeezes in before you run out of muscle.

Be sure that you have the whole muscle in your hand so that you don’t end up pinching the skin on top of the muscle. As well, don’t put your fingers too far around the front of the neck. You don’t want to choke your partner.

In the back of the neck you have extensor muscles that hold the head upright. Because of poor posture and extended periods of sitting at computers, these muscles can become very tight, tender and achy.

To massage the neck extensors, stand to the side of your partner. If you are standing on the right side, you will make a C-shape with your left hand. Drape this hand over the back of the neck. Press gently into the sides of the neck with your fingers and thumbs (Figure 4). While maintaining this gentle pressure, do a large circular kneading action with your hand. The movement may remind you of picking a cat up by the back of the neck. This technique is usually referred to as a C-lift or C-scoop.

Do a half-dozen circles in one spot and then move up or down the neck an inch and repeat. Massage along the whole length of the neck. Be careful not to pinch the skin at the back of the neck. Move the skin with the fingers instead of sliding over the skin, so that you don’t burn or irritate the skin.

Lastly, you’ll do a little kneading action to the base of the skull (Figure 5). This is where the extensor muscles attach into the head. To do this, cup your hand around the base of the skull. Gently rest your free hand on your partner’s forehead to support the head. Now move the fingers in a small circular motion, pressing into the skull as you knead. Do six to eight little circles.

Again move the skin and hair with your fingers instead of sliding so that you don’t pull the hair. Lift the fingers and move them a little closer to the center. Repeat the kneading action. Do several sets of these. To do the other side of the skull, move to the opposite side of your partner.

Finish off your massage with several gentle stroking actions down the head and back. These techniques should take about five minutes to perform. If you want to massage longer, simply do more sets of each technique. If you have any questions or would like more tips on how to give a simple massage, ask your massage therapist.